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International Journal of Legal Medicine

Published in:

01-09-2015 | Original Article

Traumatic injuries after mechanical cardiopulmonary resuscitation (LUCAS™2): a forensic autopsy study

Authors: Christelle Lardi, Coraline Egger, Robert Larribau, Marc Niquille, Patrice Mangin, Tony Fracasso

Published in: International Journal of Legal Medicine | Issue 5/2015

Abstract

Aim

The aim of our study was to compare traumatic injuries observed after cardiopulmonary resuscitation (CPR) by means of standard (manual) or assisted (mechanical) chest compression by Lund University Cardiopulmonary Assist System, 2nd generation (LUCAS™2) device.

Methods

A retrospective study was conducted including cases from 2011 to 2013, analysing consecutive autopsy reports in two groups of patients who underwent medicolegal autopsy after unsuccessful CPR. We focused on traumatic injuries from dermal to internal trauma, collecting data according to a standardised protocol.

Results

The study group was comprised of 26 cases, while 32 cases were included in the control group. Cardiopulmonary resuscitation performed by LUCAS™2 was longer than manual CPR performed in control cases (study group: mean duration 51.5 min; controls 29.4 min; p = 0.004). Anterior chest lesions (from bruises to abrasions) were described in 18/26 patients in the LUCAS™2 group and in 6/32 of the control group. A mean of 6.6 rib fractures per case was observed in the LUCAS™2 group, but this was only 3.1 in the control group (p = 0.007). Rib fractures were less frequently observed in younger patients. The frequency of sternal factures was similar in both groups. A few trauma injuries to internal organs (mainly cardiac, pulmonary and hepatic bruises), and some petechiae (study 46 %; control 41 %; p = 0.79) were recorded in both groups.

Conclusion

LUCAS™2-CPR is associated with more rib fractures than standard CPR. Typical round concentric skin lesions were observed in cases of mechanical reanimation. No life-threatening injuries were reported. Petechiae were common findings.

Kouwenhoven WB, Jude JR, Knickerbocker GG (1960) Closed chest cardiac massage. JAMA 173:1064–1067CrossRefPubMed

Jude JR, Kouwenhoven WB, Knickerbocker GG (1961) Cardiac arrest: report of application of external cardiac massage on 118 patients. JAMA 178:1063–1070CrossRefPubMed

Plaisance P, Adnet F, Vicaut E et al (1997) Benefit of active compression-decompression cardiopulmonary resuscitation as a pre-hospital advances cardiac life support. A randomised multicentre study. Circulation 95:955–961CrossRefPubMed

Wik L (2000) Automatic and manual mechanical external chest compression devices for cardiopulmonary resuscitation. Resuscitation 47:7–25CrossRefPubMed

Steen S, Liao Q, Pierre L, Paskevicius A, Sjöberg T (2002) Evaluation of LUCAS, a new device for automatic mechanical compression and active decompression resuscitation. Resuscitation 55:285–299CrossRefPubMed

Gaxiola A, Varon J (2008) Evolution and new perspective of chest compression mechanical devices. Am J Emerg Med 26:923–931CrossRefPubMed

Rubertsson S, Karlsten R (2005) Increased cortical blood flow with LUCAS: a new device for mechanical chest compressions compared to standard external compressions during experimental cardiopulmonary resuscitation. Resuscitation 65:357–363CrossRefPubMed

Tambe SP, Rasmussen VG, Modrau IS (2012) Continuous mechanical chest compression using the LUCAS-2 device as a bridge to emergency aortic valve surgery. J Cardiothorac Vasc Anesth 26:e50–e52. doi:10.1053/j.jvca.2012.03.015 CrossRefPubMed

Putzer G, Braun P, Zimmermann A, Pedross F, Strapazzon G, Brugger H, Paal P (2013) LUCAS compared to manual cardiopulmonary resuscitation is more effective during helicopter rescue—a prospective, randomised, cross-over manikin study. Am J Emerg Med 31:384–389. doi:10.1016/j.ajem.2012.07.018 CrossRefPubMed

10.

Himmelhoch SR, Dekker A, Gazzniga AB (1964) Closed-chest cardiac resuscitation. A prospective clinical and pathological study. N Engl J Med 270:118–122CrossRefPubMed

11.

Buschmann CT, Tsokos M (2009) Frequent and rare complications of resuscitation attempts. Intensive Care Med 35:397–404. doi:10.1007/s00134-008-1255-9 CrossRefPubMed

12.

Pinto DC, Haden-Pinneri K, Love JC (2013) Manual and automated cardiopulmonary resuscitation (CPR): a comparison of associated injury patterns. J Forensic Sci 58:904–909. doi:10.1111/1556-4029.12146 CrossRefPubMed

13.

Baubin M, Sumann G, Rabl W, Eibl G, Wenzel V, Mair P (1999) Increased frequency of thorax injuries with ACD-CPR. Resuscitation 41:33–38CrossRefPubMed

14.

Hoke RS, Chamberlain D (2004) Skeletal chest injuries secondary to cardiopulmonary resuscitation. Resuscitation 64:327–338CrossRef

15.

Smekal D, Johansson J, Huzevka T, Rubertsson S (2009) No difference in autopsy detected injuries in cardiac arrest patients treated with manual chest compressions compared with mechanical compressions with the LUCAS™ device—a pilot study. Resuscitation 80:1104–1107. doi:10.1016/j.resuscitation.2009.06.010 CrossRefPubMed

16.

Englund E, Kongstad PC (2006) Active compression-decompression CPR necessitates follow-up post mortem. Resuscitation 68:161–162CrossRefPubMed

17.

Fanton L, David JS, Gueugniaud PY, Malicier D (2008) Forensic aspects of automated chest compression. Resuscitation 77:273–274. doi:10.1016/j.resuscitation.2007.12.012 CrossRefPubMed

18.

Mateos-Rodriguez A, Pardillos-Ferrer L, Navalpotro JM et al (2010) Kidney transplant function using organs from non-heart-beating donors maintained by mechanical chest compressions. Resuscitation 81:904–907. doi:10.1016/j.resuscitation.2010.04.024 CrossRefPubMed

19.

Wang CH, Chou NK, Becker LB et al (2014) Improved outcome of extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest—a comparison with that for extracorporeal rescue for in-hospital cardiac arrest. Resuscitation 85:1219–1224. doi:10.1016/j.resuscitation.2014.06.022 CrossRefPubMed

20.

Field JM, Hazinski MF, Sayre MR et al (2010) Part 1: Executive summary. 2010 American Heart Association Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 122:640–656. doi:10.1161/CIRCULATIONAHA.110.970889 CrossRef

21.

Idris AH, Becker LB, Ornato JP et al (1996) Utstein-style guidelines for uniform reporting of laboratory CPR research. A statement for healthcare professionals from a task force of the American Heart Association, the American College of Emergency Physicians, the American College of Cardiology, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, the Institute of Critical Care Medicine, the Safar Center for Resuscitation Research, and the Society for Academic Emergency Medicine. Writing Group. Circulation 94:2324–2336CrossRefPubMed

22.

European Concil of Legal Medicine, Harmonization of medico-legal autopsy, Updated version October 2012, available at http://eclm.org/docs/Documents/Harmonization_of_Medico_legal_Autopsy_Protocol_.pdf. Accessed 13 October 2014

23.

Smekal D, Lindgren E, Sandler H, Johansson J, Rubertsson S (2014) CPR-related injuries after manual or mechanical chest compressions with the LUCAS™ device: a multicentre study of victims after unsuccessful resuscitation. Resuscitation. doi:10.1016/j.resuscitation.2014.09.017 PubMed

24.

Baubin M, Rabl W, Pfeiffer KF, Benzer A, Gilly H (1999) Chest injuries after active compression-decompression cardiopulmonary resuscitation (ACD-CPR) in cadavers. Resuscitation 43:9–15CrossRefPubMed

25.

Krischer JP, Fine EG, Davis JH, Nagel EL (1987) Complications of cardiac resuscitation. Chest 92:287–291CrossRefPubMed

26.

Liao Q, Sjöberg T, Paskevicius A, Wohlfart B, Steen S (2010) Manual versus mechanical cardiopulmonary resuscitation. An experimental study in pigs. BMC Cardiovasc Disord 10:53. doi:10.1186/1471-2261-10-53 CrossRefPubMedPubMedCentral

27.

Xanthos T, Pantazopoulos I, Roumelioti H et al (2011) A comparison of autopsy detected injuries in a porcine model of cardiac arrest treated with either manual or mechanical chest compressions. Eur J Emerg Med 18:108–110. doi:10.1097/MEJ.0b013e32833e79cf CrossRefPubMed

28.

McKay DR, Fawzy HF, McKay KM, Nitsch R, Mahoney JL (2010) Are chest compressions safe for the patient reconstructed with sternal plates? Evaluating the safety of cardiopulmonary resuscitation using a human cadaveric model. J Cardiothorac Surg 5:64. doi:10.1186/1749-8090-5-64 CrossRefPubMedPubMedCentral

29.

Cho J, Chung HS, Chung SP, Kim Y-M, Cho YS (2010) Airway scope vs. Macintosh laryngoscope during chest compressions on a fresh cadaver model. Am J Emerg Med 28:741–744CrossRefPubMed

30.

Wininger KL (2007) Chest compressions: biomechanics and injury. Radiol Technol 78:269–274PubMed

31.

Lederer W, Mair D, Rabl W, Baubin M (2004) Frequency of rib and sternum fractures associated with out-of-hospital cardiopulmonary resuscitation is underestimated by conventional chest X-ray. Resuscitation 60:157–162CrossRefPubMed

32.

Oberladstaetter D, Braun P, Freund MC, Rabl W, Paal P, Baubin M (2012) Autopsy is more sensitive than computed tomography in detection of LUCAS-CPR related non-dislocated chest fractures. Resuscitation 83:e89–e90. doi:10.1016/j.resuscitation.2011.12.003 CrossRefPubMed

33.

Hashimoto Y, Moriya F, Furumiya J (2007) Forensic aspects of complications resulting from cardiopulmonary resuscitation. Legal Med 9:94–99CrossRefPubMed

34.

Hood I, Ryan D, Spitz WU (1988) Resuscitation and petechiae. Am J Forensic Med Pathol 9:35–37CrossRefPubMed

35.

Raven KP, Reay DT, Harruff RC (1999) Artifactual injuries of the larynx produced by resuscitative intubation. Am J Forensic Med Pathol 20:31–36CrossRefPubMed

36.

Maxeiner H (2001) Congestion bleeding of the face and cardiopulmonary resuscitation—an attempt to evaluate their relationship. Forensic Sci Int 117:191–198CrossRefPubMed

37.

Maxeiner H, Jekat R (2010) Resuscitation and conjunctival petechial haemorrhages. J Forensic Leg Med 17:87–91. doi:10.1016/j.jflm.2009.09.010 CrossRefPubMed

38.

Bush CM, Jones JS, Cohle SD, Johnson H (1996) Paediatric injuries from cardiopulmonary resuscitation. Ann Emerg Med 28(1):40–44CrossRefPubMed

39.

Perkins GD, Woollard M, Cooke MW et al (2010) Pre-hospital randomised assessment of a mechanical compression device in cardiac arrest (PaRAMeDIC) trial protocol. Scand J Trauma Resusc Emerg Med 18:58. doi:10.1186/1757-7241-18-58 CrossRefPubMedPubMedCentral

40.

Rubertsson S, Silfverstolpe J, Rehn L et al (2013) The study protocol for the LINC (LUCAS in cardiac arrest) study: a study comparing conventional adult out-of-hospital cardiopulmonary resuscitation with a concept with mechanical chest compressions and simultaneous defibrillation. Scand J Trauma Resusc Emerg Med 21:5. doi:10.1186/1757-7241-21-5 CrossRefPubMedPubMedCentral

41.

Rubertsson S, Lindgren E, Smekal D et al (2014) Mechanical chest compressions and simultaneous defibrillation vs. conventional cardiopulmonary resuscitation in out-of-hospital cardiac arrest: the LINC randomised trial. JAMA 311:53–61. doi:10.1001/jama.2013.282538 CrossRefPubMed

Title: Traumatic injuries after mechanical cardiopulmonary resuscitation (LUCAS™2): a forensic autopsy study
Authors: Christelle Lardi
Coraline Egger
Robert Larribau
Marc Niquille
Patrice Mangin
Tony Fracasso
Publication date: 01-09-2015
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Legal Medicine / Issue 5/2015
Print ISSN: 0937-9827
Electronic ISSN: 1437-1596
DOI: https://doi.org/10.1007/s00414-015-1146-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Traumatic injuries after mechanical cardiopulmonary resuscitation (LUCAS™2): a forensic autopsy study

Abstract

Aim

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Aim

Methods

Results

Conclusion

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